House Narrowly Passes Bill to Repeal and Replace the Affordable Care Act

Labor News

Paul Ryan, the House Speaker, pushed through a bill that, if it ever goes into effect, could upend one-sixth of the American economy and result in tens of millions of Americans losing their health coverage.
PHOTOGRAPH BY TOM WILLIAMS / AP

The House on Thursday narrowly approved a bill to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering their promise to reshape American health care without mandated insurance coverage.

The vote, on President Trump’s 105th day in office, keeps alive the Republican dream to unwind the signature legislative achievement of former President Barack Obama. The House measure faces profound uncertainty in the Senate, where the legislation’s steep spending cuts will almost certainly be moderated. Any legislation that can get through the Senate will again have to clear the House and its conservative majority.

Just before the House vote, the Senate on Thursday gave final approval to a $1.1 trillion spending bill that will finance the government through September, and unlike the health care legislation, the spending bill had broad bi-partisan support.

Passage of the health care bill completed a remarkable act of political resuscitation, six weeks after House leaders failed to muster the votes to pass an earlier version of their bill, a blow to Trump and Speaker Paul Ryan of Wisconsin. …

… Republicans … disregarded the absence of a final cost estimate from the nonpartisan Congressional Budget Office — Congress’s official scorekeeper — on how much the bill would cost and how many people would receive health-care coverage. Several said that last-minute changes to the legislation won’t significantly change the final estimates. …

The bill faces a steeper climb in the Senate, where widespread disagreement remains among Republicans about how to proceed on health care. First, the Senate’s parliamentarian — or rules-keeper — cannot review the legislation and determine the rules of debate until the CBO submits its official estimate, which could take several more weeks to complete, according to congressional aides. That would mean that official Senate debate on the bill could not begin until June. …

“A number of House Republicans, especially those from competitive districts, weren’t overly enthusiastic about fulfilling the health-care suicide pact that Paul Ryan, the House Speaker, was forcing on them,” writes John Cassidy in The New Yorker. “Ultimately, though, a number of countervailing factors won out: loyalty to the Party, eagerness to score a legislative win, hostility toward Barack Obama, free-market ideology, and a reluctance to antagonize wealthy G.O.P. donors. On Thursday afternoon, when it came time to vote on the American Health Care Act of 2017, only twenty Republicans broke ranks, allowing the bill to pass by the slightest of margins. …